Medicare Part B (Doctors and Outpatient Services)
What is Medicare Part B
Many Medicare recipients ask the question “What is Medicare Part B? Part B covers medical costs like doctors, specialists, outpatient procedures and tests. Part B is just one part of “Original Medicare” coverage. The other portion, Medicare Part A, covers hospitalization. Most people supplement Parts A and B with a Medicare Part D prescription drug plan and a Medicare Supplement Plans, or “Medigap” policy that pays some of the costs that Medicare doesn’t. Or you can enroll in a Medicare Advantage, or Part C Medicare, plan that provides Medicare coverage through private insurance.
What Does Medicare Part B Cover
Medicare Part B covers medically necessary treatment for an injury, illness or health condition. It also covers certain types of preventive care. The major benefits of Part B include:
- Doctor visits, including specialists, an annual physical and a second opinion before surgery
- Lab tests
- Tests such as X-rays, MRIs, CT Scans and EKGs
- Outpatient surgery
- Emergency room visits, including an ambulance if needed
- Some diagnostic tests, like mammograms and colonoscopies
- Medical equipment needed at home, like walkers and oxygen
- Mental health treatment
- Flu shots
Part B covers most of your medical expenses, but it does not provide dental or vision benefits. It also does not cover custodial care, such as help with bathing and dressing or the cost of an assisted living facility.
Medicare Part B Benefits Chart 2017
|wdt_ID||Service||Benefit||Medicare Pays||You Pay|
|1||Medical Expenses||Physicians services, inpatient and outpatient medical services and supplies, physical and speech therapy, diagnostic tests, and durable medical equipment||80% of approved amount (after $183 deductible); 100% for clinical laboratory services; (certain limits may apply for physical, speech and occupational therapy)||$183 deductible plus 20% of the balance of the Medicare approved amount|
|2||Home HealthCare (Including skilled nursing care, home health aide services, etc.)||Unlimited as long as you meet Medicare requirements||100% of approved amount for services; 80% of approved amount for durable medical equipment||Nothing for services; 20% of approved amount for durable medical equipment|
|3||Outpatient Hospital Treatment||Unlimited treatment as medically necessary||100% after coinsurance or copay amount||A coinsurance or copay amount, which may vary according to the service|
|4||Blood||Unlimited during a benefit period if medically necessary||80% of approved amount (after first 3 pints and $183 deductible)
||$183 deductible plus 20% of the balance of the Medicare approved amount
|5||Preventive Services||Healthcare to prevent illness or detect illness at an early stage, when treatment is likely to work best including the "Welcome to Medicare" preventive visit and yearly "Wellness" visit. Preventive services include Pap tests, flu shots, and screening mammograms.||100% of coinsurance or copay amount||Nothing for covered services. However, if your doctor or other healthcare provider performs additional tests or services during the same visit that are not covered under the same preventive benefits, you may have to pay coinsurance (20%) and the $183 deductible may apply.
|1||Once you pay the $183 of expense for covered services in 2017, the Part B deductible does not apply to any further covered services you receive the rest of the year. Also, if your physician does not accept Medicare assignment, he/she may not bill you for more than 15% over Medicare's approved amount.|
Cost of Medicare Part B
Another frequently asked question is “What is the cost of Medicare Part B?” There’s a monthly premium for Part B coverage. If you receive Social Security, your premium will be deducted from your monthly check. The standard Medicare Part B premium is listed in the benefits chart above, but most people pay a little less than that. However, you may pay a higher premium if your 2015 income was more than $107,000 for an individual or $170,000 for a couple.
Like most health insurance, Part B has a deductible, which is provided in the chart above. After you have met your deductible, Medicare pays 80 percent of the Medicare-approved cost of your medical expenses. In most states, if your doctor accepts Medicare but doesn’t think Medicare pays enough for a service, the doctor can add an extra 15 percent to the Medicare rate – and you are responsible for paying these “excess charges.”
To help with these out of pocket costs, many people buy a Medicare Supplement, or “Medigap” plan. Most Medigap plans pay your 80 percent coinsurance, and a few types of plans cover the Part B deductible and/or excess charges.
Medicare Part B Enrollment
If you are already getting Social Security benefits when you turn 65, you will automatically be enrolled in Medicare Parts A and B. Otherwise, you can sign up during an open enrollment or special enrollment period. Everyone has a seven-month Part B open enrollment period that begins three months before the month you turn 65 and ends three months after the month you turn 65.
If you or your spouse is still working when you turn 65 and you are covered under an employer health insurance plan, you don’t have to sign up for Part B right away. You qualify for a special enrollment period that allows you to enroll in part B, penalty-free, around the time your employer coverage ends.
If you don’t qualify for this special enrollment period and didn’t sign up when you turned 65, you can still enroll in Part B during the open enrollment period from January 1st to March 31st each year. However, you will probably pay a late enrollment penalty – a higher premium for the entire time you have Part B — and your coverage will not take effect until July 1st.
Resources Available to You
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